‘Global Health Funding’ is a process of financing worldwide healthcare systems. Many countries and health organizations work in collaboration (as donors, managers & distributing bodies) to accomplish the task.The Development Assistance Committee (DAC) of the Organization of Economic Cooperation & Development (OECD) and the European Commission are the mainstays of global health finance.
Global healthcare funding has seen a surge over the last few decades, i.e., the Development Assistance for Health (DAH) grew from $2.5 billion in 1990 to almost $14 billion in 2005. In 2011, funds for global health touched $35 billion with the United States providing at least one-third of this total. (Christopher et al., 2011)
In 2013, the global funding trends were estimated to be round about the US $38 billion, which was a great global achievement. In 2017, the world reached the highest health funding, i.e., almost US $40 billion while in 2018, it reduced to an estimated $37 billion. In 2016, the DAH global health spending was $8 trillion with a per capita spending of US $5252 in high-income countries, $491 in upper-middle-income countries, $81 in lower-middle-income countries, and $40 in low-income countries (The Lancet, 2019).
Let us now see the funding stats from different fields of biomedical sciences.According to the World Health Organization (WHO), the economic impact of cancer is significant and is rising. The total annual economic cost of cancer in 2010 was estimated to be $1.16 trillion. The nexus of cancer research policymaking is the interplay between funding and activity (Seth, Grant, & Richard, 2008). In the first comparative study of European and USA spending on cancer research, Eckhouse and Sullivan (2006) found the latter outspent the former 3 to 5 times as a percentage of GDP or per capita.
In 2017, the National Institute of Cancer (NCI) spent about:
- $545 million for breast cancer research
- $320 million for lung cancer
- $233 million for prostate cancer
- $178 million for pancreatic cancer, &
- $108 million for ovarian cancer
Meanwhile, the National Institute of Health received about US$5.6 billion healthcare research reflecting an increase of 7% (or $368 million) from the previous fiscal year.In 2010, the HIV/AIDS dedicated funds were $11.2 billion, which rose up to $11.8 billion in 2012. However, the time period between 2014–2018 has seen a decline of about $9.5 billion in AIDS research, which is a cause of concern for lower income countries and the Funding Authorities.
On the other hand, the funds for TB research hit the maximum in 2017 of $1.9 billion but saw a decline to $1.6 billion in 2018.The Global Fund is an organization that provides nearly 60 percent of international financing for malaria and has invested more than $10.5 billion in malaria control programs in more than 100 countries from 2002-2017.
From the year 2000 to 2014, the number of deaths caused by malaria globally declined by nearly 50%, which means that an estimated 6.8 million lives were saved by an investment of $2.3 billion – the amount which is expected to be doubled by the year 2020 as targeted.
However, news of the past was not as encouraging. In 2017, only $2.4 billion was invested in malaria control (which is less than half of the year 2020 funding target).
In 2018, health funding for Malaria was even lesser than the previous year, i.e., $2.1 billion. Nonetheless, Paraguay and Uzbekistan were certified malaria-free in 2018, hence, achieving their milestone.
The WHO’s Global Malaria Program calls for malaria annihilation from at least 35 countries by the year 2030. Still, total domestic and international funding for malaria is inadequate to achieve WHO global targets in burden reduction by 2030. (Michael et al., 2017)
The Global Fund, in partnership with The President’s Malaria Initiative (PMI) and Bill & Melinda Gates Foundation, has promised $33 million in fast funding to facilitate with mosquito nets designed to protect against mosquitoes that have become resistant to current nets.
Supplementary economic output, gained by eradicating malaria by the year 2030, is likely to be $4 Trillion.The funding trends of NIH Dermatology, for fiscal years 2009–2014, curtailed by 4.6%, i.e., from $67.3 million in 2009 to $64.2 million in 2014, with rock bottom of $58.6 million in 2013. The NIH Research Grant Program (R01) also downsized by 21.0% from $43.9 million to $34.7 million between 2009 and 2014.
The total NIH budget in adjusted dollars has constantly decreased since 2003 which is a major concern for academic dermatologists who rely on the NIH for research support (Cheng, Kim, Maverakis, Sukhov, & Sultani 2016). The downward trend of NIH-funded females is particularly concerning because the NIH awards play a vital role in career advancements in the field of health.The average worldwide mental health spending per capita is currently $2.5 million (2017). In 2015, the global health spending per capita totaled to $141 million, thus making government mental health spending less than 2% of average global government health expenditure.
The statistics on mental health trends have upgraded in 2017 fiscal year because 80 countries are now able to report data as compared to 40 countries in 2014 but still, less than 50% of the WHO Member States report which makes data limited. It is also observed that about 83% of the global population pays nothing (fully insured) or at least 20% of mental health services cost, which shows optimism of the DAH towards this field.
Many funding initiatives provide exemplary platforms for testing and systematizing innovative strategies for training, mentorship, and building a research culture and other infrastructural support for mental research. These include:
- Fogarty International Center’s Global Brain and Nervous System Disorders
- Across the Lifespan program
- The NIMH’s Collaborative Hubs for International Research in Mental Health
- Grand Challenges Canada’s Global Mental Health granting program
The WHO’s Global Mental Health Action Plan 2013-2020, focuses on increasing mental health care insurance by 20% for severe mental health illness and reducing national suicide rates by 10%.Researches in the surgical field, funded by agencies like the NIH in the United States, are continuously producing breakthroughs. However, the success rates of grants funding applications related to the field of surgery are much lower than nonsurgical applications due to relative underfunding in all major health institutes.
Shawn, Bradley, and Lawrence (2002) found that awards for surgical grants averaged from 5% to 27% less than nonsurgical grants; surgeons exhibited 35% to 65% less peer-review activity relative to nonsurgeons.
In comparison, from 2008 to 2013, charitable organizations provided nearly $27 billion for global health, meaning an estimated 11.5 % went to surgery. In short, the cost of scaling up surgical care in low- and middle-income countries (LMIC) over the years 2012–2030 is estimated at $300-420 billion or 4–8 % of annual total health spending.Worldwide, health funding has been facing numerous challenges since the start. Many factors hamper the funding provision, such as:
- Resource limitations
- Priority selectionbarriers
- Social and culturalbarriers
The top challenges to healthcare are:
- Insufficient financial support from domestic sources
- Weak local health care system, i.e., infrastructure may collapse if foreign resources leave.
- Lack of basic life necessities; e.g., clean water, adequate nutrition, etc.
- Weak infrastructure; e.g., poor road construction and physical access; unreliable power supply; weak telecommunication
- Violence or political instability
This is why we must jump-start efforts from where the progress has stopped and commit to the sustained investment needed to reach the goals made by health funding agencies globally.The health and the economic blow the LMICs receive is the driving factor for perpetual economic deterioration and poverty. Having this in mind, The Global Fund’s fundraising goal is at least US$14 billion. This will help save 16 million lives and cut the death rate, from HIV, TB, and malaria, in half by 2023, while building a sturdy health system. The Global Alliance for Vaccines and Immunizations has positively affected vaccine access. Henceforth, annihilating the epidemics of HIV, TB, and malaria by 2030 is within our grasp. Child mortality is also decreasing by the year.
Over the past two decades, the governments’ increased prioritization of the health sector has in return increased global economy which is projected to continue increasing in the future, although at a slower pace of growth and with persistent discrepancies in per-individual health spending between countries.
- Anderson B., Burstein R., Leach-Kemon K., Murray, C. J., Schneider M., Tardif A.,… Zhang R. (2011, July 2). Development Assistance For Health: Trends And Prospects. The Lancet, 378(9785), 8–10. https://doi.org/10.1016/S0140-6736(10)62356-2
- Global Burden of Disease Health Financing Collaborator Network. (2019, April 25). Past, Present, And Future Of Global HealthFinancing: A Review Of Development Assistance, Government, Out-Of-Pocket, And Other Private Spending On Health For 195 Countries, 1995-2050. The Lancet. 6736(19), 30841–4. https://doi.org/1016/S0140-6736(19)30841-4
- Eckhouse S., Lewison G., & Sullivan, R. (2008, March 27). Trends In The Global Funding And Activity Of Cancer Research. Mol Oncol, 2(1), 20–32. http://dx.doi.org/1016/j.molonc.2008.03.007
- Cheng, M. Y., Kim, K., Maverakis, E., Sukhov, A., & Sultani, H. (2016, May 18). Trends in National Institutes of Health Funding of Principal Investigators in Dermatology Research by Academic Degree and Sex. JAMA Dermatol, 152(8), 883–888. http://dx.doi.org/10.1001/jamadermatol.2016.0271
- Efron, B., Moss, R.L., & Rangel, S.J. (2002, September 23). Recent Trends in National Institutes of Health Funding of Surgical Research. Ann Surg, 236(3), 277–287.